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(TJ;,~ ~ LOCAL PERMIT OR CHARITY LOCAL PERMIT OFFICE OF ATTORNEY GENERAL (Jpr ('1~a..,.,}A ~ h~'{"lA;t, 5hmM \;Je.., SFN 17926 (09-2007) ~ rlll Or~ ~ prt):;:f. P Type: Local Permit .. !8l Charity Local Permit Permit Number 423 Name of Organization Red River Valley Fair Association Contact Person Bryan Schulz Mailing Address P. O. Box 797 Date(s) Authorized (Read instruction 2) Site Name Red River Valley Speedway City West Fargo Check the Game( s) Authorized: Business Phone Number 6/1/2008 (701) 282-2200 City West Fargo Site Address 1201 West Main Avenue Slate Zip Code County ND 58078-0000 Cass , Poker. Twenty-one. and Paddlewheels may be Conducted only by a Charity Local Permit. to 9/30/2008 Ending Zip Code 58078-0797 o Bingo o Raffle Qg Calendar Raffle o Sports Pool o Poker' o Twenty-one' o Paddlewheels' Restriction: Requirement: For a "Charity Local Permit," the organization must file a "Report on a Charity Local Permit" with the city or county auditor and Office of Attorney General within 30 days of the event. Date Printed Name of City or County Auditor Auditor TelephoneNumber 6/2/2008 Michael Montplaisir (701) 241-5600 Please see the instructi ns on the backs'ide of this form on how to complete the Permit. For a raffle or calendar raffle, read "Information Required to be Preprinted on a Standard Raffle Ticket" on tbe backside of the form. cut along this line -------------------------- BINGO EXCISE TAX North Dakota Century Code 953-06.1-12(2) requires that organizations who conduct bingo pay an excise tax of three percent on the gross proceeds from the sale at retail of bingo cards to final users. Please complete the form below and send with payment to: If the organization conducts bingo under a Local Permit or Charity Local Permit the organization must complete the "Bingo Excise Tax Return for Local Permit or Charity Local Permit" SFN 58649, and submit this form with payment of the Bingo Excise Tax to the Office of Attorney General within 30 days from the authorized ending date. Gaming Division Office of Attorney General 600 E Boulevard Ave. - Dept. 125 Bismarck ND 58505-0040 BINGO EXCISE TAX RETURN FOR LOCAL PERMIT OR CHARITY LOCAL PERMIT OFFICE OF ATTORNEY GENERAL SFN 58649 (08-2007) Permit Number undefined List the Permit Number assigned on the Local Permit or Charity Local Permit -Bingo Excise Tax Due $ X .0291 = , 8ingo Gross Proceeds * Report the total gross proceeds from the sale of bingo cards during the date(s) authorized on the Permit. Name of Organization Signature of Preparer Per N.D. Admin. Code 999-01.3-01-01, an organization is ineligible for a license or permit if the organization is delinquent in paying any tax.